鼻内镜下鼻中隔穿孔修补术

Endoscopic surgery for nasal septal perforation

目的探讨经鼻内镜下鼻中隔穿孔修补术影响手术成功率的相关因素。方法23例外伤或手术后鼻中隔穿孔患者采用经鼻内镜下穿孔修补术,术中分别采用筛骨垂直板或颞肌筋膜直接封闭穿孔、翻转黏膜瓣及赝复物夹衬并转移黏膜瓣封闭、下鼻甲带蒂黏膜瓣修补等方法进行修复,并采用硅胶板或塑料膜的保湿物垫衬保护为特点的填塞方式。结果直接封闭7例,翻转封闭5例,转移封闭10例,鼻甲封闭1例。随访4周至7个月,23例鼻中隔穿孔手术修补成功19例(82.6%),4例未成功的病例分别为术后3周黏膜瓣脱落1例、术前存在2个穿孔仅将大穿孔修补成功1例、术后筋膜干燥导致再穿孔1例及转移黏膜瓣太小,穿孔未完全修补成功1例。结论鼻内镜手术是目前修补鼻中隔穿孔的最佳选择之一。

Objective To describe the relevant factors of endoscopic surgery in patients with nasal septal perforation. Methods Twenty-three patients with nasal septal perforation were treated under nasal endoscope. Four kinds of reconstruction materials were used to accomplish the closure of perforation：residual osseous septum or temporalis fascia, inverting septal mucoperichondrial flap, autologous connective tissue insert overlaid with mucous flaps and turbinate flap. The reconstructed septum was packed by moist dressing with silicone or plastic splints. Results Seven patients underwent direct closure. Inverting flap repair for five cases, shifting flap closure for ten cases, and repair with turbinate flap in one case. During the follow-up ranging from four weeks to seven months, the successful reconstruction was achieved in 19 cases（82. 6% ）. The problems in the remaining four cases were： mucosal flap displacement, fascia flap shrank and so caused reperforation, two perforations present with only the larger one repaired, the mucosal flap was smaller in size than the perforation. Conclusions Intranasal endoscopic reconstruction surgery is a reasonable management for nasal septal perforation.